Re-thinking care models for Finnish HICUs

As Finnish psychiatric hospitals have gone through a large scale renewal with new multifunctional hospital buildings replacing campuses built 70 to 130 years ago, it has been necessary to re-think and update such facilities' and their services. Psychiatric high-intensity care, and the use of isolation and restraint, are among the practices that have seen major changes in the intervening years, and the spaces for such care had become unfit-for-purpose and sometimes even non-compliant from a legal perspective.

This large-scale renewal of Finland's psychiatric hospitals, and particularly the HICUs within them, present a great design opportunity to propose solutions that communicate today's values and highlight the emphasis on wellbeing in our society. How we treat the most vulnerable says a lot about the values of our time.

When designing the HICUs for the new hospitals, a design team consisting of architects, care professionals, and hospital administrators, set the objectives for the practical functionality of the new spaces, including the key safety considerations (for both patients and staff), and those around service-user privacy. The laws in Finland relating to the spaces used for involuntary care state only the service-users rights' (for instance, access to outdoor space, if their condition allows this), so the design solution was the team's interpretation of how these rights are realised in the units.1,2 Furthermore, the team recognised these spaces as both critical and very hard to design in a way that supports healing and reflects dignity and respect. It was perhaps our biggest challenge in the design process.